Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Feb 2018
ReviewConventional Computed Tomography and Magnetic Resonance in Brain Concussion.
Conventional neuroimaging is still the mainstay in the assessment of the acute, follow-up, and chronic settings of concussion and mild traumatic brain injury (mTBI). Computed tomography (CT) is preferred for the initial assessment of acute mTBI, repeat evaluation in acute mTBI with neurologic deterioration, and cautious use in children with mTBI. Clinical rules have been developed to identify pediatric and adult patients with mTBI who can safely forego CT. Magnetic resonance (MR) imaging is mostly used in patients with acute mTBI when initial or follow-up CT is normal and there are persistent neurologic findings and in subacute or chronic mTBI.
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Neuroimaging Clin. N. Am. · Feb 2018
ReviewPET and Single-Photon Emission Computed Tomography in Brain Concussion.
This article offers an overview of the application of PET and single photon emission computed tomography brain imaging to concussion, a type of mild traumatic brain injury and traumatic brain injury, in general. The article reviews the application of these neuronuclear imaging modalities in cross-sectional and longitudinal studies. Additionally, this article frames the current literature with an overview of the basic physics and radiation exposure risks of each modality.
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Traumatic brain injury (TBI) is a significant problem worldwide and neuroimaging plays a critical role in diagnosis and management. Recently, perfusion neuroimaging techniques have been explored in TBI to determine and characterize potential perfusion neuroimaging biomarkers to aid in diagnosis, treatment, and prognosis. In this article, computed tomography (CT) bolus perfusion, MR imaging bolus perfusion, MR imaging arterial spin labeling perfusion, and xenon CT are reviewed with a focus on their applications in acute TBI. Future research directions are also discussed.
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In the United States alone, 1.6 to 3.8 million people have sports-related concussions yearly. The patho-mechanisms of concussions may not be directly measured by conventional neuroimaging; advanced models may be needed to address the shortcomings of the current clinical protocols. Multimodal advanced imaging may provide more accurate diagnosis and predict the clinical course of concussion, assessing the efficacy of existing and emerging multifaceted therapies. In this article, the authors present an overview and pictorial display of conventional and advanced multimodal MR imaging methods that have been applied to identify the brain structures affected in traumatic brain injuries.
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Remarkable advances have been made in the last decade in the use of diffusion MR imaging to study mild traumatic brain injury (mTBI). Diffusion imaging shows differences between mTBI patients and healthy control groups in multiple different metrics using a variety of techniques, supporting the notion that there are microstructural injuries in mTBI patients that radiologists have been insensitive to. Future areas of discovery in diffusion MR imaging and mTBI include larger longitudinal studies to better understand the evolution of the injury and unravel the biophysical meaning that the detected changes in diffusion MR imaging represent.